Clinical Case Manager, Behavioral Health - Field-MI (Wayne and Macomb County)

CVS Health•Detroit, MI

4d•Remote

About The Position

This role coordinates care for members with long-term rehabilitation or psychosocial needs related to birth defects, chronic conditions, illness, or injury. The Clinical Case Manager works to prevent exacerbations, readmissions, and placement in custodial care by coordinating case management, psychosocial, and quality-of-life activities across the continuum of care. This includes consultant referrals, home care visits, community resources, and alternative levels of care. The role develops and carries out strategies to integrate acute and long-term care services and provides psychosocial interventions through resource identification and program development. The position may specialize in a disease area and may serve as a consultant to other health care professionals. The role manages members with acute or chronic conditions, conducts initial and periodic assessments, and develops individualized case plans for members at risk of poor outcomes. It communicates with providers and care teams, identifies appropriate care available under members’ benefit plans in home or community settings, and provides information and education about social issues, mental health, and available services. The position also develops programs to reduce admissions, increase community integration, and improve health outcomes; coaches junior colleagues; and collaborates with community members, organizations, and policymakers. The position is work at home with 25–50% travel throughout Wayne and Macomb Counties. The schedule is Monday through Friday, 8:00 a.m. to 5:00 p.m. ET. Reliable transportation is required, and mileage is reimbursed under the company expense reimbursement policy.

Requirements

Minimum experience in medical social work or case management; the required number of years is not specified.
Comply with all state requirements in the state where job duties are performed.
Be willing and able to travel up to 25–50% of the time in Wayne and Macomb Counties.
Have reliable transportation.
Basic awareness of problem-solving and decision-making skills.
Basic awareness of digital literacy skills.
Basic knowledge of medical terminology.
Ability to deal tactfully with customers and the community.
Ability to handle sensitive information ethically and responsibly.
Ability to weigh the relative costs and benefits of potential actions and choose an appropriate option.
Ability to function in a clinical setting with diverse cultural dynamics among clinical staff and patients.
Master’s degree in Social Work, as required by state law.
LMSW.

Nice To Haves

Behavioral health experience.
Bilingual in Spanish or Arabic.

Responsibilities

Coordinate care for members with long-term rehabilitation or psychosocial needs to help prevent exacerbations, readmissions, and custodial care placement.
Implement and coordinate case management, psychosocial, and quality-of-life activities across the continuum of care, including referrals, home care visits, community resources, and alternative levels of care.
Develop and carry out strategies to coordinate acute and long-term care services for members in case and disease management.
Provide psychosocial interventions through resource identification, program development, and other means.
Manage members with acute or chronic conditions, focusing on quality of care, compliance, outcomes, and cost reduction.
Conduct initial and periodic assessments of members in Long-Term Care, case management, or disease management programs to determine a course of treatment.
Develop individualized case plans for enrolled members at risk of poor outcomes.
Communicate patient-status updates and facilitate discussions with providers, primary care physicians, Medical Directors, pharmacists, and care management staff.
Identify opportunities for members to receive necessary care covered by their benefit plans in home or community settings.
Provide information, resources, and education on social issues, mental health, and available services.
Develop programs to reduce admissions, increase community integration, and improve health outcomes.
Coach junior colleagues in social work techniques, processes, and responsibilities.
Collaborate with community members, organizations, and policymakers to create opportunities, address community issues, and raise awareness.
Travel 25–50% of the time throughout Wayne and Macomb Counties.